In a significant turn of events, a federal study released on Thursday reveals that smoking illicit drugs, such as heroin and fentanyl, has surpassed injecting them as the primary method leading to fatal overdoses. This shift has substantial implications for efforts to combat the alarming increase in opioid-related deaths, not only in Massachusetts but across the nation.

For the past two decades, much attention has been focused on the perils of injecting illicit drugs and the risks associated with needle-sharing. However, the study conducted by the federal Centers for Disease Control and Prevention (CDC) shines a light on the importance of adapting harm-reduction strategies to address the growing number of individuals smoking opioids.

The findings raise questions about whether enough is being done at the state level to mitigate the deadly risks faced by those who choose to smoke drugs instead of using injectable methods. Addiction treatment specialists argue that the shift to inhaling drugs necessitates the modification of existing strategies to minimize the number of deaths.

Dr. Miriam Harris, an addiction expert, emphasizes the critical need for inhalation spaces and the importance of shifting strategies accordingly. This shift in drug-using habits comes at a juncture where harm-reduction advocates and local officials are endorsing supervised consumption sites, also known as safe injection sites, to provide a controlled environment for individuals to consume illicit drugs under the supervision of trained professionals. However, these sites would now need to accommodate not only injectable drugs but also provide "inhalation spaces" to cater to those who opt for smoking as their preferred method.

Currently, due to legal obstacles, only two supervised drug consumption sites exist in the country, both located in New York City, with another scheduled to open in Providence later this year. Advocates for safe consumption sites argue that if these sites are to respond effectively to the evolving crisis, plans for additional brick-and-mortar facilities must consider the needs of individuals who inhale stimulants and other substances.

According to the CDC study, there has been a drastic change in the leading causes of drug overdose deaths in recent years. The number of fatal overdoses with evidence of smoking has surged by 109 percent, accounting for 23 percent of these deaths between January to June 2020 and July to December 2022. On the contrary, fatal overdoses resulting from injections have seen a sharp decline and represented only 16 percent of overdose deaths over the same period. This trend is consistent across all regions of the country.

In Massachusetts, injection remains the primary pathway to overdose deaths, but smoking-related overdoses are rising at a much faster rate. The percentage of overdose deaths with evidence of smoking has more than quadrupled, reaching 16.9 percent in 2022, compared to 3.9 percent in 2020. In contrast, overdose deaths with evidence of injection drugs rose from 12.1 percent to 19.7 percent during the same period.

The increase in overdose deaths related to smoking may be partly attributed to the growing practice of polysubstance use, where potent synthetic opioids are mixed with stimulants like cocaine and counterfeit pain pills, which are commonly smoked. Additionally, the shift to smoking drugs may reflect a broader change in drug-using habits, as individuals perceive smoking to carry a lower risk of bloodborne and infectious diseases compared to injecting.

However, the CDC warns that inhaling illicit substances can intensify the effects of drugs and increase the risk of overdose. The study shows that nearly 80 percent of overdose deaths with evidence of smoking involved no evidence of injection. Moreover, individuals who use drugs by smoking may not take advantage of traditional harm-reduction programs that provide syringe services and other supplies.

The devastating impact of fentanyl, a cheap and highly potent opioid, combined with the mixing of opioids with stimulants like cocaine and methamphetamine, have contributed to the rise in overdose deaths. In 2022, Massachusetts witnessed a record-high of 2,359 overdose fatalities, more than triple the number from a decade ago.

Allyson Pinkhover, director of substance use services at Brockton Neighborhood Health Center, underscores the importance of including "safer smoking supplies" in harm-reduction efforts. Providing clean pipes, rubberized mouthpieces, and alcohol swabs can significantly reduce the transmission of diseases like hepatitis C.

The study urges a better understanding of the risks associated with smoking drugs and emphasizes the positive impact that providing safer smoking supplies can have on users' health and engagement in care. The alarming rise in overdoses linked to smoking emphasizes the need for a comprehensive approach to address this evolving crisis and protect individuals from potentially fatal consequences.